title: Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy for the treatment of breast cancer.
abstract: BACKGROUND
  Accelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed post-lumpectomy in eligible patients with breast cancer. Patient and tumor characteristics as well as the lumpectomy technique can influence patient eligibility for APBI. This report describes a lumpectomy procedure and examines patient, tumor, and surgical characteristics from a prospective, multicenter study of electronic brachytherapy.
  
  
  METHODS
  The study enrolled 65 patients of age 45-84 years with ductal carcinoma or ductal carcinoma in situ, and 44 patients, who met the inclusion and exclusion criteria, were treated with APBI using the Axxent® electronic brachytherapy system following lumpectomy. The prescription dose was 34 Gy in 10 fractions over 5 days.
  
  
  RESULTS
  The lumpectomy technique as described herein varied by site and patient characteristics. The balloon applicator was implanted by the surgeon (91%) or a radiation oncologist (9%) during or up to 61 days post-lumpectomy (mean 22 days). A lateral approach was most commonly used (59%) for insertion of the applicator followed by an incision site approach in 27% of cases, a medial approach in 5%, and an inferior approach in 7%. A trocar was used during applicator insertion in 27% of cases. Local anesthetic, sedation, both or neither were administered in 45%, 2%, 41% and 11% of cases, respectively, during applicator placement. The prescription dose was delivered in 42 of 44 treated patients.
  
  
  CONCLUSIONS
  Early stage breast cancer can be treated with breast conserving surgery and APBI using electronic brachytherapy. Treatment was well tolerated, and these early outcomes were similar to the early outcomes with iridium-based balloon brachytherapy.
authors.affiliation: University of Oklahoma Health Sciences Center, 825 NE 10th Street Suite 4500, Oklahoma City, OK 73104, USA. William-Dooley@ouhsc.edu
authors.forename: William C
authors.initials: WC
authors.lastname: Dooley
authors.forename: Ozer
authors.initials: O
authors.lastname: Algan
authors.forename: Kambiz
authors.initials: K
authors.lastname: Dowlatshahi
authors.forename: Darius
authors.initials: D
authors.lastname: Francescatti
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tito
authors.forename: J David
authors.initials: JD
authors.lastname: Beatty
authors.forename: Art G
authors.initials: AG
authors.lastname: Lerner
authors.forename: Betsy
authors.initials: B
authors.lastname: Ballard
authors.forename: Susan K
authors.initials: SK
authors.lastname: Boolbol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011446:Prospective Studies